Respiratory medicine · 2025
Outcomes of introducing shared decision-making for tracheostomy on prolonged intubated critical patients.
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Kuo Shu-Hung, Hsu Chien-Wei, Huang Wei-Chun, Yin Chun-Hao, Li Ying-Chun, Lin Tsung-Hsien, Chen Yao-Shen, Chen Jin-Shuen
Аннотация
AIM: Tracheostomy has been relatively unpopular in Taiwan. Here, we investigate the impact of shared decision-making (SDM) for tracheostomy on critical patients undergoing prolonged intubation.
METHODS: We retrospectively enrolled 1464 patients admitted to a tertiary medical centre intensive care unit (ICU) due to respiratory failure between April 2017 and April 2023. A 2-to-1 propensity-score with nearest-neighbour matching was used to balance covariates across SDM and non-SDM groups. Outcomes, including tracheostomy rate, intubation to tracheostomy time, mortality rate, ventilator weaning rate, ICU admission days, length of hospital stay, and 6-month post-discharge readmission rate were collected. Binary outcomes (Tracheostomy rate, in-hospital mortality, and 6-month readmission rate) were analysed using multivariable logistic regression, reported as odds ratios (ORs) with 95 % confidence intervals (CIs). Continuous outcomes (Intubation to Tr. T, ICU days, and length of stay) were assessed with generalized linear models, reported as regression coefficients (β) with 95 % CIs.
RESULTS: We found that SDM introduction was associated with a higher tracheostomy (44.3 % vs. 30.9 %, p < 0.001) and lower in-hospital mortality rates (15.7 % vs. 26.5 %, p = 0.004), but failed to demonstrate significant impacts on the intubation-to-tracheostomy time (25.8 ± 16.8 vs. 28.8 ± 17.6 d, p = 0.05) and the rest of the clinical outcomes. Subgroup analysis showed SDM had the greatest benefit to those with prior respiratory, neuromuscular, and malignant diseases.
CONCLUSION: Introducing SDM for prospective tracheostomy recipients is associated with better clinical outcomes in critical patients undergoing prolonged intubation.
METHODS: We retrospectively enrolled 1464 patients admitted to a tertiary medical centre intensive care unit (ICU) due to respiratory failure between April 2017 and April 2023. A 2-to-1 propensity-score with nearest-neighbour matching was used to balance covariates across SDM and non-SDM groups. Outcomes, including tracheostomy rate, intubation to tracheostomy time, mortality rate, ventilator weaning rate, ICU admission days, length of hospital stay, and 6-month post-discharge readmission rate were collected. Binary outcomes (Tracheostomy rate, in-hospital mortality, and 6-month readmission rate) were analysed using multivariable logistic regression, reported as odds ratios (ORs) with 95 % confidence intervals (CIs). Continuous outcomes (Intubation to Tr. T, ICU days, and length of stay) were assessed with generalized linear models, reported as regression coefficients (β) with 95 % CIs.
RESULTS: We found that SDM introduction was associated with a higher tracheostomy (44.3 % vs. 30.9 %, p < 0.001) and lower in-hospital mortality rates (15.7 % vs. 26.5 %, p = 0.004), but failed to demonstrate significant impacts on the intubation-to-tracheostomy time (25.8 ± 16.8 vs. 28.8 ± 17.6 d, p = 0.05) and the rest of the clinical outcomes. Subgroup analysis showed SDM had the greatest benefit to those with prior respiratory, neuromuscular, and malignant diseases.
CONCLUSION: Introducing SDM for prospective tracheostomy recipients is associated with better clinical outcomes in critical patients undergoing prolonged intubation.